Is it safe to use talcum powder?

What could be more wholesome than Johnson & Johnson’s talcum powder? It is the fragrant way to dry the bits towels can’t reach. Up to 40% of women may use talc at least occasionally. But last week a Missouri jury awarded $72m (£51.5m) in damages to the family of Jackie Fox, who died of ovarian cancer having used the well-known brand of powder for years. More than 1,200 other cases are still waiting to be heard.

The scientific evidence linking talcum powder to ovarian cancer is not overwhelming, but the trial saw an internal memo from a medical consultant employed by Johnson & Johnson that suggested that “anybody who denies [the] risks” between “hygienic” talc use and ovarian cancer would be publicly perceived in the same light as those who denied a link between smoking cigarettes and cancer.

The solution

Three years ago I wrote about a paper linking talc to an increased risk of ovarian cancer. It is a debate that has rumbled on for decades. Talc is naturally occurring and consists of magnesium, silicon, hydrogen and oxygen. It is mined from the soil and, before 1973, was often contaminated with asbestos (a naturally occurring close neighbour in the ground).

Last year, a court awarded a woman in California $13m for developing mesothelioma (a tumour of the lining of the lungs) from using talc with asbestos in it – the tiny fibres in talc are easily inhaled. Removing the asbestos, however, did not stop some studies continuing to link talc with ovarian cancer. A 2003 meta-analysis looking at 16 studies involving 11,933 women found talc was associated with a higher risk of ovarian cancer, but a 2014 study of 61,576 women found no such link. The International Agency for Research on Cancer (part of the WHO) has classified talc applied to the genitals as “possibly carcinogenic”. The studies that have found the weak links have been case-control studies that compare the use of talc by women with ovarian cancer to those without it. They rely on self-reported talc use, which is not terribly reliable.

There is a plausible mechanism by which talc could promote cancer – by triggering long-term inflammation. But since ovarian cancer is uncommon, the use of talc will only raise a small risk by a smallish amount (up to a third). There are stronger risks for ovarian cancer, such as genetic abnormalities, hormone replacement therapy and being overweight. Studies do not show a relationship between the amount of talc used and the likelihood of ovarian cancer – if there was a strong link they would do. But while talc may not be unsafe, a fluffy towel is safer. The popularity of talc is already waning and won’t be helped by more lawsuits.